Characteristics of Multiple Myeloma Patients on Dialysis Who Receive Autologous Stem Cell Transplant

Introduction Renal impairment is part of the natural progression of multiple myeloma (MM); as such up to 40% of MM patients present with some degree of renal disease at diagnosis. Within this cohort, severe chronic kidney disease (CKD) requiring hemodialysis (HD) is present in up to 10% of MM patients. HD dependence may prevent clinicians from pursuing bone marrow transplant (BMT) referral, the current standard-of-care for MM, in this higher risk population for fear of increased complications. Here we explore the co-morbidities of MM patients on HD who receive autologous bone marrow transplantation (ABMT), as well as length of stay (LOS) in hospital, blood product support, and 2-year survival following transplantation. We hope to illustrate the feasibility of ABMT among HD-dependent MM patients and better understand this population's needs. Methods We conducted a retrospective chart review of 476 patients with MM who received peripheral blood stem cell transplant (PBSCT) identifying patients who were HD dependent. We excluded MM-patients whose pre-transplant disease status was unavailable (n=228), those who identified as Jehovah's Witness (n=6), those who underwent a second transplant (n=38), and patients who did not achieve Complete Remission (CR) or Very Good Partial Remission (VGPR). We considered 33 observations from 33 patients for the analysis. We looked at characteristics preceding transplant such as demographics and co-morbidities as well as characteristics following transplant including length of stay in hospital, blood product support, and 2-year survival. Results The median age of the entire patient cohort at transplant was 57 years, 67% were male, and 52% were African American. The median body mass index (BMI) was 29 kg/m2 (range 20-42). In terms of co-morbidities, 61% had hypertension (HTN), 21% had diabetes mellitus (DM), 15% had depression, 12% had hyperlipidemia (HLD), 6% had hypercholesterolemia (HCL), 6% had anemia, and 3% had past history of cancer. The median transplant hospital admission LOS was 16 days (range 10-84); the median LOS in the hospital following transplant was 14 days (range 8-81). The median number of both platelet (plt) and red blood cell (RBC) transfusions was two units (RBC range 0-9; plt range 0-18). The 2-year survival across the cohort was 88%. Conclusion Our study describes the characteristics of HD-dependent MM patients who have undergone ABMT. Clinicians can use these findings to anticipate the requirements of this specific population. The prevalence of co-morbidities in combination with low median transfusion requirements demonstrates that, despite procedural risks, clinicians should have a low threshold for seeking ABMT for MM patients on dialysis. Continued research is needed to predict and improve the outcomes of HD-dependent MM patients who have undergone ABMT.